Medical revision blog

About the nMRCGP Applied Knowledge Test (AKT)

The AKT is a relatively new exam. It was introduced in 2007 by the Royal College of General Practitioners (RCGP) as part of their radical shake-up of membership assessment and is described by the college as a “summative assessment of the knowledge base that underpins independent general practice in the United Kingdom within the context of the National Health Service”.

You should already be aware of the basic facts about the AKT exam:

200 questions of the best-of-five and extended matching type

3 hours

Approximately 80% of question items will be on clinical medicine, 10% on critical appraisal and evidence based clinical practice and 10% on health informatics and administrative issues

Around 73% of people passed the AKT at the last sitting

Over the last couple of years the AKT has gained somewhat of a reputation for asking obscure and detailed questions. This partly reflects recall bias (candidates remember best the unusual questions they couldn’t answer) and also an attempt by the RCGP to keep the exam fresh and unpredictable. Whilst this can be frustrating (there’s no better feeling than recognising a question during an exam) the RCGP should be commended for trying to maintain the integrity of the AKT. This approach contrasts to some other postgraduate exams where similar questions are used year-on-year resulting in the exam being more about reviewing past papers rather than studying the curriculum.

The January 2010 feedback report makes interesting reading. In it the Royal College describe how they have taken steps to increase the difficulty of the exam after concerns were made regarding patient safety. Previously around 80% of candidates passed the exam and there was no limit on the number of attempts a candidate could make. The pass rate has now fallen to 73% for the last sitting and the College have stated that the lower pass rates are here to stay.

Given the wide scope of general practice revising for the exam can seem a daunting task. For some candidates it may have been several years since they last took a substantive written exam. We still feel the best approach to passing the AKT is to cover the core areas (NICE guidelines, contraception, common drugs etc) sufficiently. This should allow you to pick up the majority of marks and will also stand you in good stead for future practice. Passmedicine concentrates on these areas. One of the biggest potential causes of not passing (other than not revising) is being a ‘big book failure’, i.e. a person who spends too much time remembering obscure facts about uncommon conditions – an approach that has a very poor yield.

The RCGP have attempted to make the AKT focus on “higher order problem solving rather than just the simple recall of basic facts”. As such part of the process of revision is learning how to work through problem based questions to find the right answer – the so called “exam technique”. The best way to hone your exam technique is simply to do as many questions as time allows. Hopefully, after revising for a while, patterns will start to emerge and you will find your average score creeping up.